Reducing Polypharmacy in the Elderly

Abstract

A prospective, controlled trial to reduce polypharmacy in patients 65 years or older was carried out in the residents' clinic of a teaching hospital. Of 272 elderly patients surveyed, 89 (33%) were taking five or more prescription drugs. Recommendations to discontinue medications or to simplify regimens were formulated for 79 polypharmacy patients. Compared to 41 controls, the 38 patients whose physicians were informed of the recommended changes demonstrated a small but significant reduction in the mean number of drugs, the complexity, and the cost of their regimens. Physicians complied with eight (100%) of eight recommendations to simplify a dosage schedule, eight (62%) of 13 recommendations to substitute a new drug for the old one, and only eight (40%) of 20 recommendations to stop a medication (P = .04). Noncompliance usually resulted from patient refusal or from medications being prescribed by another provider. Whereas feedback to the primary physician is beneficial, more substantial reductions in outpatient polypharmacy may require overcoming patient barriers and limiting the number of prescribing physicians.

Effect of number and type of antidiabetes medications on adherence and glycemia of ambulatory type 2 diabetes patients in southwestern Nigeria

“…In the present study, majority of patients were placed on more than four medications per contact with physician which probably supported studies that reported multi-drug regimens as a natural consequence of providing evidence-based care to patients with type 2 diabetes 29,32,43,44. Typically, more than one medication is required to control hyperglycemia and the associated metabolic risk factors of hypertension and hyperlipidemia which are common comorbid among diabetes patients 31,32…”

“…The consensus is that number of medications prescribed for a patient is inversely correlated with adherence to treatment regimen 29,30,31. However, possible reduction in adherence with multiple medications has been cited as an important issue among patients with type 2 diabetes who are expected to take more than one medication to control hyperglycemia and the associated metabolic risk factors of hypertension and dyslipidemia which are common comorbid among diabetes patients 31,32,33…”

A Critical Review of Admission and Discharge Medications in an Elderly Australian Population

“…Kroenke and Pinholt (1990) suggested that the number of physicians attending a patient needs to be minimised, and patient attitudes towards medications need to be altered.…”

Acute Confusional States In Older Adults And The Role Of Polypharmacy

“…Many clinicians and researchers have questioned the wisdom and rationale of polypharmacy in the elderly (5, 49,51,61,70). The use of multiple concurrent medications may predispose the older person to iatrogenic illness, including adverse drug reactions, drug-drug interactions, and decreased medication compliance (41) (Figure 1).…”